Friday, July 1, 2011

ADHD and Angry Outbursts

One of the most difficult things to deal with in any child, and especially in an ADHD child, are the angry, uncontrollable outbursts. Not all children have them, but the ones that do can become very scary, and often violent.

These children are usually normally very pleasant, and can be fun to be around. However, it seems like in one minute they can turn from Dr. Jekyll to Mr. Hyde. The explosion seems to come out of nowhere. Often it is related to things they can't do, or making them do things they don't want to do. They may run to their room and slam the door, but it is harder when they yell, scream, break things, hit their siblings, and even hit their parents.

This is one of the most common causes parents put children on medication. The anger and violence can become scary and sometimes siblings are at risk. If the parents can find no other recourse, this may be the best thing to do for the moment.

When it comes to medication in this problem, often a combination of a stimulant and an anti-seizure drug, like Neurontin, may help the best. The Neurontin calms the excessive firing of the brain neurons with a sudden outburst, and often the children are calmer. If the child is bordering on bipolar psychosis, an anti-psychotic drug may be necessary.

But there are other possibilites that may work. Using supplements similar to the ADD Focus Boost AM and ADD Calm Time PM will often assist the child in calming. Sometimes, though not always, Neurontin or another anti-seizure medication may continue to be needed, but rarely are two medications needed when using the supplements. Also cut out as much as possible sugar and chemicals in food, especially artificial sweeteners and food colorings. Check for food allergies and low blood sugar, which can increase the anxiety and irritability in a child.

There are also some behavioral techniques, which, if repeated consistantly and practiced by parent and child alike, will assist the child in learning to control his own emotions better over time.

1. Of course, Be the example.
If you lose your temper easily, that is what the child learns. If you get angry, rather than explode, take a minute to go to your room and calm down. When you are calm and the anger has left, then you may choose to talk to the child about their behavior from a more peaceful and loving way. You can even tell your child, "Mommy was mad for a minute, but rather than yell at you I went to my room to calm down. Now I am calm let's discuss what happened. If you get angry while we talk, you may want to go to your room for a minute to calm down as well."

2. Acknowledge their feelings and don't make them bad for having them.
The feelings come out of nowhere for the child. They truly come so quickly that they immediately react. They usually don't like their anger any more than you do. Teach the child that it is ok to be angry about something, but not ok to hurt things or other people because of that anger. For example, you may say "I understand why you are angry. You want to watch this TV show and I won't let you. Of course you are angry when you don't get what you want. That's normal. You believe the TV show won't hurt you, but there are things in this TV show that I have seen increase the times you become angry and hit others. I don't think either one of us what that. You may get angry but it doesn't work for anyone when you yell at and hit your brothers. Let's find something else to do that may be fun. I know you would rather watch the TV show, but since you can't, let's go outside and play ball for a moment." They may still rather pout than play ball, but often acknowledging that you recognize that his anger is normal often softens the blow and they calm down to a degree.

3. Assist them in finding a positive outlet when they are angry.
At times when they are not angry, discuss with them ways that they can get their anger out rather than yelling, hitting and destroying. There is a powerful release of adrenaline with sudden anger, and it is important for them to move in order to get it out. Make sure they know that anger is normal but it doesn't work to hurt others by yelling, hurting or destroying from the anger. Help them make a list of things to do when they are angry until they find one that really works for them. The list may include: punching on a punching bag, a punching clown or on a pillow; running around the outside of the house three times; jumping on the trampoline or on the bed; going in the closet and yelling all of the things they want to yell at you or someone else; slamming a garage door that is outside the house over and over. I knew one family that got cheap dishes at yard sales, and they had a spot next to the fence in the back yard where their kids could throw dishes (you may want to find something safer than glass, and use plastic dishes to throw). That way they can be "safely destructive."

4. Find the underlying cause of the anger.
The child who is always angry usually has underlying fears and/or anger about things other than what she is angry about. Most children are not very self-aware, and may not be able to express fears and deep-seated anger. They just feel, and when the feelings get strong it comes out as an angry explosion or as withdrawal. There are several causes: a traumatic event such as death, divorce or abuse, anger in the family such as a frequently angry parent or parents frequently arguing (the children not only learn angry responses from parents, they are sensitive and feel the anger and take it on as their own), or their sense of security is threatened. Take a hard look at the influences on your child's life. What builds her up? What tears her down? What needs aren't being met? What may the inner fears and anxieties be? The anger is a protective shell that keeps the real fears tucked away. Sometimes counseling is necessary.

5. Find the good child under the misbehavior.
Sometimes a child's behavior is so much more "bad" than "good" that it is hard to find something to praise the child for. But when a child is constantly told or shown how bad they are, it becomes a truth in their subconscious mind, and then they give into negative behaviors because they believe they really are "bad." It is devastating to a child to believe he is a "bad" kid. He feels that he has no choice, and no matter how hard he tries he will never be "good." Keep telling your child things such as, "You're not bad, you are just young and made a mistake. We all make mistakes but as we grow up we learn to make less and less. You are still learning. Daddy and Mommy are going to help you learn from those mistakes so that you can grow up into the nice person you really are." It is important for YOU to recognize the real child, the loving and caring child, deep within the misbehavior, and not consider him a bad child.

6. Praise more than you may believe the child deserves.
Most of the time these children don't learn from punishment, except how to lie and cover up their "bad" behaviors, or run away to avoid punishment. These children learn much more from praise and being inspired into good behavior. I believe by being "attention deficit," these children have a "deficit" of "attention." They need a lot of attention, more than other children, and when they don't get the attention their brains desire they will do anything to get it, even to get negative attention. This is most likely due to their lack of dopamine, and positive attention increases their dopamine levels.

Find anything you can to praise them (but don't forget to praise your other, non-ADHD children as well!). If they got up on time but left their clothes all over the floor, praise them for getting up on time. Praise them for paying positive attention to their younger siblings. Praise them for sitting still for 5 minutes, even though in 6 minutes they were up running around. These children learn much better from praise and rewards than from punishment.

7. Use "and" instead of "but."
These kids generally don't like to work. That is one of the big issues they get angry about. It seems to be a personal affront that you are forcing them to do something they don't want to do. Force doesn't work for these kids, but then how do we get them to learn to do their chores, homework, and help out? This is hard, but it is important to find ways to inspire them to do what is best for them to do. One of the ways is to use the word "and" instead of "but." Using the word "but," to a child, means they are in trouble and they don't want to hear it.

When your child got up on time but left their clothes all over the floor, you may say "I'm so pleased that you got up on time! Way to go, Susie! And I'll bet you can pick up your clothes quickly, too! I'll set the timer, and see if you can get them all picked up before the timer rings." That works much better for the child than "It's good you got up on time but you forgot to pick up your clothes. You'd better get that done before breakfast!"

Or, if your child completed a chore but was grouchy about it and got angry at his sister, you might say, "You did it! Great job, Billy! And now let's talk about how we can deal with your sister in a different way. Any ideas?"

Or if your child completed the chore but did a very poor job, you can say "Wonderful, sweetheart, you finished it! The sink is nice and clean. And now let's just make the toilet a little cleaner by scrubbing right here." You may choose to work together with your child until you know they know how to do it well, praising every step. The next time they will be more likely to the job better on their own, and be sure to praise the parts that were done well.

8. Find something to laugh about.
Even though the child just threw a destructive tantrum and broke a window, laughter diffuses the situation and keeps the child from feeling "bad." "Well, now you have air conditioning in your room!" There are still consequenses to their behavior, but give the consequences in love and laughter rather than anger and yelling, and they will learn better from them. When the parents are angry giving a consequence, the child becomes defensive and feels justified. When the parents are loving and laughing when giving a consequence, the child is not thinking how mean the parents are, but more about what they did.

9. Role play.
When you talk to your child at a time she isn't angry and she seems to feel sorry for her behavior, she may be ready to learn new ways to respond to things that normally would make her angry. Role play certain situations that she often gets angry about until she can come up with a way to diffuse the anger. One way is with laughter. When she is not allowed to do something she wants to do and she begins to get angry, she can think of doing that thing on a pogo stick, and see herself bouncing around doing what she wanted to do but on a pogo stick. It is silly. Another way is to use made up name calling to the person she is angry at, using non-negative words. "Brownie face!" "Oh, yeah? Snickerdoodle noodle!" etc. This usually ends up in laughter. Then practice doing it several times until it is easier for her to come up with the diffusing behavior than following through with the angry behavior.

10. Pick your battles.
Angry ADHD children seem to have an innate knowledge of how to push your personal buttons and get you riled up. They will sometimes do every behavior they can to get you angry. Take time to yourself and with your spouse to decide which behaviors to ignore and which are really important. You may choose to spend energy dealing with the shoplifting so many of these kids do but not spend a lot of attention on their habit of constantly leaving their plate on the table, or not having their shirt tucked in and their hair combed. That can come later. Family life doesn't work well when you are battling every little thing with your child. You may choose to pick 5 things that are most important and focus on them until they are learned. Then you can go on to other things.

11. Let go of your own guilt.
Yes, you are going to lose it sometimes. We all do. We are simply human, after all, and kids know how to push our buttons. Let go of guilt and just consider how you might chose to do it differently next time. The most important thing is to love your child (remember, fear and worry are the opposite of love). When your child really knows you love him in spite of his weaknesses and your weaknesses, he can work through your mistakes as you can work through his. Remember to express your love sincerely and frequently. You can apologize when you know you made a mistake, but don't apologize for disciplining their angry behavior. "Charity [love] covereth a multitude of sins." 1 Peter 4:8.

Please comment and let us know anything you may be doing that has worked, or what your struggles are that aren't working. We can all come together to serve each other.

You can get ADD Focus Boost AM, ADD Calm Time PM and SuperMulti Plus (children should take 1/2 to 1 capsule) at www.springtreehealth.com.

Until we meet again,
Dr. Judi

11 comments:

Stephanie said...

Judi,

In your ADHD blogs, the symptoms and the supplements always refer to how they relate to children. I struggle with some pretty bad ADHD symptoms. I'm 31. Would the supplements be useful for an adult? Or can you recommend some that would be effective in an adult?

Thank you,
Stephanie

Dr. Judi said...

Yes, the supplements will help adults but since these are children's doses you would need to take more. In the future I plan to do an adult version, but for now you could take 2 ADD Focus Boost AM 2 to 3 times a day depending on your symptoms, and 2-3 ADD Calm Time PM at bedtime. You would also want to take SuperMulti Plus 4 capsules a day, and at your age, Adrenal Stress Relief would probably also help, 2 in the morning.

Let me know how it works for you.

Anonymous said...

I have an 11 year old son. During the past few months, when he has meltdowns, he commonly unleashes a barrage of profanity. When this happens, I try to remain calm and tell him to go to his room, which he does. When he calms, I explain to him why this behaviour is unacceptable and suggest other ways to release frustration. Still, the frequency of profanity persists. Any suggestions?

Anonymous said...

Hi I don't know if this is still a active sight.. My 9 year old little girl has trouble with bed-time the feeling of sleepiness. She doesn't relax and is a restless sleeper. There are even times when she wakes and sneaks food in the night. Late nights makes for really rough days. How can I help her?

Anonymous said...

I have a bit of a different problem. My mother-in-law has anger outbursts and actually has temper tantrums if my 8 year old son does not want to go with her somewhere. My son is not real well aquainted with her as her and my father-in-law go RVing 6-8 months out of the year. I may point out she has also did this type of thing to her other grandchildren, all of whom are old enough to now avoid her. My husband wants our son to have a relationship with her, but as things are, it's not going to happen. I have tried to explain to her that my son unfortunately does not see them often and hasn't since he was very young and regards her as a little more than a stranger, and her behavior certainly does not help, by the way my son is respectful. Her response was"he better get used to it, because I intend to travel as much as I can". When she doesn't get her way, she belittles him. I would also like to mention that although she and my husband's step-father had custody of him, she was a emotionally absent and neglectful parent. Please give me some guidence, as my husband gets frustrated with me at times, saying I don't push my son to spend time with his parents, but how can I under the cirstances??

Dr. Judi said...

There are several reasons a child doesn't sleep well. One of the most common is a reduction of alpha waves in the occipital part of the brain, and too many beta waves. Alpha waves assist in the calm relaxed state of the brain, such as in meditation and calming the brain to relax and go to sleep. Beta waves are the busy, focused waves that keep the brain thinking.

This is common if there is some anxiety in the child's life. They often don't know how to express anxiety, but can be worriers or possibly nervous about problems at home or at school. Often a child reacts to a parent's concerns and fears.

Doing calming things before bed may help, such as a warm bath, reading a story together with your arm around her, having a little talk about the problems of the day, followed by finding the successes of the day. Often kids have a hard time seeing their success, and parents have a hard time as well! Take time to look for the ways she is striving to do well, if she got up in time in the morning, if she did well on a school assignment, if she did something nice for one of her siblings, etc. Ending the day on a positive note, and seeing the next day as a positive time, helps calm the child.

Supplements that may help are melatonin, 5-HTP, Valerian root, etc. You can do a trial of them separately, or combine them if individually they don't work.

If she is getting up to eat, she may be experiencing low blood sugar. Giving something healthy to eat before bed may help her sleep better through the night.

Good luck!
Dr. Judi

Dr. Judi said...

I'm sure that you understand there is nothing you can do to change your mother-in-law. If your son truly does not want to visit her, it does not serve to force him. However, to appease your husband, you might have him encourage them to come visit at your house. Then your son will have both of you to feel safer with.

If she chooses not to come, then your husband could see that she is not really that interested in seeing your son, but in having control. Most people get angry when something is not in their control.

Best wishes in finding a peaceful and loving outcome.
Dr. Judi

Sara said...

Hello Dr. Judi,

My 4 year old nephew had ADHD. His tantrums are extremely violent and he gets thrown out of school every single day. Please let me know if I can give him ADD Focus Boost AM , ADD Calm Time PM and Super Multiplus as well.

He doesn't sit in one place, doesn't make eye contact. Slaps people, his teachers and his parents and if he wants something, he better get it. We are tired of changing schools. I am looking for a solution that would address his problems. Rather than trying all the OTC and generic supplements, I felt as though your blog had good information in explaining the ADHD/ADD problem well.

However, please also provide a list of side effects that we should expect to see with these medications.

Are these herbal or natural or are they alopathic drugs?

Thanks, Sara

Wanda Blom said...

I have a 10 year old son that has very bad anger outburst. His grades are very good, but does get angry when playing with others and they don't want to do things his way. I have tried putting him on ADD meds< but it only made him more angry. Its is a battle with him every day over the smallest things, like getting dressed for school. I stay calm and try to talk to him, but it does not help. I have sent him for anger management, but it did not help. plz help.

Dr. Judi said...

Anger outbursts are difficult to treat, because it is important to get to the root of the anger. That is why medications sometimes don't help. Often there has been abuse, emotional, physical, or even sexual. A good pediatric counselor who can work with the root cause, whatever it may be, may be more successful than medication.

One medication that sometimes helps angry kids is oxytocin. This is a hormone, the same "Pitocin" that is given to start labor, and it is released while nursing to increase bonding between mother and baby. It is released during sex, and often kids with behavioral problems or autistic children are low in oxytocin. It comes as a shot, but can be made into cream, sublingual drops, nasal spray, etc. by a compounding pharmacist.

Also do a trial of going off all sugar, and eating more healthy. Often low blood sugar will cause a child to lose control. Protein at every meal and healthy snacks between meals will keep his blood sugar more stable.

Good luck!

Anonymous said...

My significant other has ADHD, and I'm wondering if the following behavior is because of that, or something else. He will hold onto me and not let me go, restricting my movements. He does this not only when he is angry, but it is of course much more intense when he is having an angry outburst.

What can I do to change this behaviour, or how can I make him understand how this makes me feel? I have tried to explain to him that it takes away my rights as a human being, and makes me feel trapped and sometimes desperate to the point where I lash out anyway I can in an effort to get away, which of course, totally exacerbates the anger/need to control the situation he is feeling in that moment.

I can deal with all the other symptoms, even the anger as long as it's 'anger from a distance'... but this is coming to the point where it is a deal breaker in the relationship. I'm about to throw in the towel and walk away because I'm not sure I can take this anymore. I'm honestly afraid someone will get hurt, and I'm pretty sure that someone will be me, as he is well capable of overpowering me in any situation.

Is there hope of controlling this behavior, or should I walk away for both our sake?